This project is designed to evaluate the prognostic utility of 1H- MR Spectroscopy (MRS) and Dynamic Contrast Enhanced MRI (DCE-MRI) in the management of squamous cell carcinoma of the head and neck (HNSCC). HNSCC is the fifth most common malignancy worldwide and affects more than 29,370 persons in the United States annually. Despite agressive surgery and radiation therapy (XRT), which may result in major functional loss, the survival rate of patients with HNSCC has remained relatively unchanged over the past 3 decades. In an effort to improve survival, chemotherapy has been incorporated in the initial non- surgical management of newly diagnosed cases. Unfortunately, there are no early or a priori markers that are predictive of treatment failure/response. The tumor microenvironment plays a critical role in malignant tumor progression and treatment resistance. Microenvironment parameters that have shown to be relevant for treatment outcome include tumor cell hypoxia and proliferation. It has been suggested that pretreatment lactate detection by 1H-MRS and DCE-MRI changes are predictive of tumor hypoxia and outcome. We propose to asssess the value of 1H-MRS and DCE-MRI for providing tools for better selection of patients. Our hypothesis is that spectroscopic changes and/or DCE-MRI changes prior to, or early in the course of chemotherapy-XRT can predict response to treatment and/or long term disease-free survival in patients treated with chemotherapy-XRT or surgery. The goals of this project are to 1. Evaluate the hypothesis that a priori or early 1 H- MRS (choline and lactate) and DCE-MRI (Akep and Ktrans) changes can reliably predict chemotherapy clinical response before apparent tumor regression and/or long term disease-free survival. 2. Determine whether the a priori 1 H-MRS and DCE-MRI changes correlate with 18F-MISO PET (18Fluoro - misonidazole Positron Emission Tomography) studies. 3. Determine whether the a priori 1 H-MRS and DCE-MRI changes correlate with selected proliferative, hypoxia molecular markers and gene array analysis. 4. Determine if the 1 H-MRS and DCE-MRI results are superior and independent markers of tumor response and/or long term disease-free survival compared to potential molecular and clinical prognosticators. If successful, it will provide an a priori predictor of failure/response to chemotherapy and/or long term disease free-survival, resulting in patient specific treatment which will likely enhance outcome.